Evolution and hypertension.

Evolution by natural selection is the supreme organizing principle of biology, but it has not been widely applied in medicine.1 Medicine has historically been concerned with mechanistic, or “proximate,” answers to questions of how diseases develop and cause pathology. In contrast, evolutionary, or “ultimate,” questions, frequently ask “why” structures or functions are as they are.2 A full explanation of a disease should ideally address both, and what follows is a review of aspects of proximate and evolutionary thinking in hypertension.